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FVrC V�rIt,C IiJ[: � , ---------------- ti APPLICATION FOR SANITATION PLIT (Complete in.Triplicate( Permit No. 7___-----Z ._ ............................. .._.. This Permit Expires 'I Year From Date Issued Date Issued /--,31-_7,9 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein I , described, This application is made in compliance with County Ordinance No. 5:49 and existing Rules and Regulations: JOB ADDRESS/LOCATION ..-.L. 7`,. C. IGj� ............................CENSUS TRACE _...------------- ------ Owner's Name ....1��_O—V------ f�Cc�«/�' --__Phone ., ----------------- ------- -----------•••. --- IAddress ------ --- •---•------•-••---............. City _ ........................... Contractor's Name/%?-_-•-- TCS ....................... ---_.License #/ � _.__ Phone - Installation will serve: Residence®"Apartment House❑ Commercial❑'frailer Court 0 Motel ❑Other . ---------- --=--------- •------- Number of living units_____________ Number of bedrooms .........---Garbage Grinder ............ lot Size ----------------.__._______. Water supply: Public System and name ................................... Private ❑- _ -----•----------------•--•------.....- Character of soil to a depth of 3 feet: Sand❑ Sil#❑ Cloy ❑ Peat❑ Sandy Loam.❑ Clay barn ❑ Hardpan 0 Adobe❑ Fill Mpterlal ............If yes,type--------------- ------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I ) Size....... •- ........... Liquid Depth .--- Capacity --�� Q._.... Type _4 ---- Material.._ ��..__ .... No. Compartments ---, f ! R i Distance.to nearest: Well .._._--•................Foundation ---- Prop. Line ...J.2L........... LEACHING LINE } No. of Lines ----- ---------_-_--- Length of each line----_7P............... Total Length -----1-4-V.-........... 'D' Box ,-_I------- Type Filter Material __ ki, Depth Filter Material -__�_ �r ............... II ( Distance to nearest: Well ........................ Foundation -.__..__. -------------------. Property tine ------------------------ j SEEPAGE PIT { } Depth -_- ------ Diameter .---_-----_--- Number -_--_- .__---. Rock Filled Yes ❑ No (3 Water Table Depth -------------------------------------••.........Rock Size ................................ Distance to nearest: Well ________________________________________Foundation .................... Prop. Line ....................... REPAIR/ADDITION(Prey. Sanitation. Permit r# ........-----------------................... bate ....................... } Septic Tank (Specify Requirements) _.................................._•-••-- c Disposal Field (Specify Requirements) __-••-------- ----------- -------------------- .........---•..........__-.......... --------•---------- ---- ------------------•-----------•••----••--• - ................................-------------------------------------------------------------- ----------------------------------------------•-_----- --•----- -----••------•-----------------•---- •--•-------• -- -- (Draw existing and required addition on reverse side) I hereby certify that l have prepared this application and that the work will he done In accordance with San Joaquin County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health;District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for'whic thi permit is Issued, I shall not employ any person in such manner as to become subject to Workman'roensatLigge California." ��Ifi Signed . `�9� �z _e7` - --••----- Owner BY -------------- ----------------•--------•-•-•-------.. Jitle ......... (if other than owner) ___._..._.._..--• FOR DEPARTMENT USE ONLY Fj APPLICATION ACCEPTED BY ---- d -.; k-:_ ��.: � ----=----------- DATE ..� ..._Z .- BUILDING PERMIT ISSUED - ______ --------------- - ---- --DATE ------ ADDITIONAL COMMENTS -------------------- - --------------------- --- - ----- -------- •---- -- -- ------- -. ------ ---- ----------_...-_....-•- F ----------- ............. ----- ------------- ------- --------- - •--- ----; -------------- -- -'.--.-- ...-..... -- ------ - -- ------------------------------------------------------------ Final Inspection b --- ��`` -------------------Date .-..- _� �.� EH 13 24 1 -68 Hev 5M SAN JOAQUIN tbCAL HEALTH DISTRICT 8/7h 3M rr�-